Does the Ileal Brake Contribute to Delayed Gastric Emptying After Pancreatoduodenectomy?

Savio G. Barreto, John A. Windsor

    Research output: Contribution to journalReview articlepeer-review

    8 Citations (Scopus)

    Abstract

    Delayed gastric emptying (DGE) represents a significant cause for morbidity following pancreatoduodenectomy (PD). At a time when no specific and universally effective therapy exists to treat these patients, elucidating other potential (preventable or treatable) mechanisms for DGE is important. The aim of the manuscript was to test the hypothesis that ileal brake contributes to DGE in PD patients receiving jejunal tube feeding by systematically reviewing experimental and clinical literature. A series of clinically relevant questions were framed related to the potential role of the ileal brake in development of DGE post-PD and formed the basis of targeted literature searches. A comprehensive search of major reference databases from January 1980 to June 2015 was carried out which included human and animal studies. The ileal brake is a feedback loop neurally mediated by the vagus and sympatho-adrenergic pathways and hormonally by gut peptides including glucagon-like peptide-1, peptide YY (PYY), and neurotensin. The most potent stimulus for this inhibitory reflex is intra-ileal fat. There is evidence to indicate the role of an inhibitory reflex (on gastric emptying) mediated by PYY and CCK which, in turn, are stimulated by nutrient delivery into the distal small intestine providing indirect support to the role of ileal brake in post-PD DGE. The ileal brake is a likely factor contributing to DGE post-PD. While there has been no study to directly test this hypothesis, there is compelling indirect evidence to support it. Designing a trial that would answer such a question appears to be the most appropriate way forward.

    Original languageEnglish
    Pages (from-to)319-335
    Number of pages17
    JournalDigestive Diseases and Sciences
    Volume62
    Issue number2
    DOIs
    Publication statusPublished - Feb 2017

    Bibliographical note

    Publisher Copyright:
    © 2016, Springer Science+Business Media New York.

    Copyright:
    Copyright 2018 Elsevier B.V., All rights reserved.

    Keywords

    • Enteral nutrition
    • Morbidity
    • Parenteral nutrition
    • Review
    • Therapeutics
    • Vomiting

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